Can oral steroids and Breo (fluticasone furoate/vilanterol) be started at the same time?

Starting Oral Steroids and Breo Simultaneously

Yes, oral steroids and Breo (fluticasone furoate/vilanterol) can be started at the same time, as there are no contraindications to concurrent initiation of these medications. 1, 2

Understanding the Medications

• Breo (fluticasone furoate/vilanterol) is a once-daily fixed combination of an inhaled corticosteroid (ICS) and a long-acting β2-adrenergic agonist (LABA) delivered via a dry powder inhaler (Ellipta®) 2
• Fluticasone furoate has enhanced affinity for the glucocorticoid receptor compared with other clinically used inhaled corticosteroids and provides 24-hour duration of action 3
• Vilanterol is a selective long-acting β2-adrenergic agonist with rapid onset (within 6 minutes) and prolonged effects over 24 hours 3
• Oral corticosteroids are systemic medications that work through anti-inflammatory, antiproliferative, immunosuppressive, and vasoconstrictive effects 1

Safety of Concurrent Initiation

• There are no known contraindications or negative interactions between oral corticosteroids and Breo that would prevent starting them simultaneously 4, 2
• In clinical practice, oral corticosteroids are often used as "burst therapy" for acute exacerbations while maintenance therapy with ICS/LABA combinations like Breo is initiated or continued 1
• For patients with moderate to severe asthma, combination therapy with both ICS/LABA and systemic corticosteroids may be necessary during periods of poor control 1

Clinical Considerations

• When starting both medications simultaneously, monitor for:

  • Potential overlapping side effects such as anxiety, insomnia, or hyperglycemia 4
  • Increased risk of oral candidiasis due to combined local and systemic immunosuppression 2
  • Proper inhaler technique to ensure effective delivery of Breo 4

• For asthma management specifically:

  • Oral corticosteroids are typically used for short-term "burst" therapy (5-7 days) while Breo provides long-term control 1
  • The combination of ICS/LABA (Breo) has been shown to reduce the need for oral corticosteroids over time 1

Dosing Considerations

• Breo is administered once daily at a consistent time 2
• Oral corticosteroids are typically dosed according to the severity of symptoms and patient characteristics 1
• No dose adjustments of either medication are required when used concurrently 4

Common Pitfalls to Avoid

• Avoid abrupt discontinuation of oral corticosteroids after extended use (>1 week); a tapering schedule is recommended 1
• Do not confuse the mild cardiovascular effects of the LABA component (vilanterol) with a drug interaction with oral steroids 4
• Remember that while both medications contain corticosteroids, they work differently - inhaled corticosteroids primarily act locally in the lungs while oral corticosteroids have systemic effects 1, 2

Special Populations

• For children, the safety profile of concurrent therapy should be carefully considered as Breo has limited data in pediatric populations 5
• In patients with cardiovascular risk factors, Breo has been studied extensively and shown to be well-tolerated even in this population 6